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<title>Health SignUp</title>
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        	<a href="index.html"><img src="images/logo.png" alt="Get Fit By Design Logo"/></a>
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                <li><a id="facebook-icon" title="Join us on Facebook" href="#"></a></li>
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			<ul>
				<li><a href="health.html" title="My Health">My Health</a></li>			
				<li><a href="fitness.html" title="Fitness">Fitness</a></li>
				<li><a href="Nutrition/index.html" title="Diet & Nutrition">Diet &amp; Nutrition</a>
					<ul>
						<li><a href="Nutrition/nutritionProfile.html" title="My Nutrition Profile">My Nutrition Profile</a></li>
						<li><a href="Nutrition/recipes.html" title="My Recipes">My Recipes</a></li>
						<li><a href="Nutrition/foodTracker.html" title="My Food Tracker">My Food Tracker</a></li>
						<li><a href="Nutrition/education.html" title="My Education">My Education</a></li>
						<li><a href="Nutrition/motivation.html" title="My Motivation">My Motivation</a></li>
						<li><a href="Nutrition/goals.html" title="My Goals">My Goals</a></li>
						<li><a href="Nutrition/nutritionFacts.html" title="Nutrition Facts">Nutrition Facts</a></li>
						<li><a href="Nutrition/nutritionResources.html" title="Nutrition Resources">Nutrition Resources</a></li>
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				<li><a href="stress.html" title="Stress Management">Stress Management</a></li>			
				<li><a href="services.html" title="Services">Services</a></li>
				<li><a href="courses.html" title="Courses">Courses</a></li>
				<li><a href="help.html" title="Help & Support">Help &amp; Support</a></li>			
				<li><span style="float: right;"><a href="login.html" title="Login">Login &raquo;</a></span></li>
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		<div class="main-content">
			<h3>My Health SignUp:</h3>			
			<ul>
				<li>
					<label for="lastname">*Last Name:</label>
					<input id="txtLastname" type="text" />
				</li>
				<li>
					<label for="firstname">*First Name:</label>
					<input id="txtFirstname" type="text" />
				</li>
				<li>
					<label for="birthdae">*Birthdate:</label>
					<input id="txtBirthDate" type="text" />
				</li>
				<li>
					<span style="font-weight: bold; padding-left: 95px;">*Sex:</span><br/>
					<input type="radio" name="rdSex" value="Male"/>Male<br/>
					<input type="radio" name="rdSex" value="Female"/>Female
				</li> 					
				<li>
					<span style="font-weight: bold; padding-left: 62px;">*Ethnicity:</span><br/>
					<input type="checkbox" name="chkBxEthnicity1" value="caucasian"/>Caucasian (non-Hispanic)<br/>
					<input type="checkbox" name="chkBxEthnicity2" value="african-american"/>African American (non-Hispanice)<br/>
				    <input type="checkbox" name="chkBxEthnicity3" value="hispanic-latino"/>Hispanic Latino<br/>
				    <input type="checkbox" name="chkBxEthnicity1" value="middle-eastern"/>Middle Eastern<br/>
				    <input type="checkbox" name="chkBxEthnicity1" value="native-american"/>Native American<br/>
				    <input type="checkbox" name="chkBxEthnicity1" value="pacific-islander"/>Pacific Islander<br/>
				    <input type="checkbox" name="chkBxEthnicity1" value="asian"/>Asian<br/>
				    <input type="checkbox" name="chkBxEthnicity1" value="otherEthnicity"/>Other - Please specify:&nbsp;
				    <input id="txtOtherEthncity" type="text" />
				</li>
				<li>
					<label for="address">*Address:</label><br /><br />
				</li>
				<li>
					<label for="city">City:</label>
					<input id="txtCity" type="text" />						
				</li>
				<li>
					<label for="zipCode">ZipCode:</label>
					<input id="txtZipCode" type="text" />						
				</li>
				<li>
					<label for="email">*Email:</label>
					<input id="txtEmail" type="text" />						
				</li>
				<li>
					<input type="checkbox" name="chkBxTexts" value="texts"/>I would like to receive texts.<br/>
				</li>
			</ul><br /><br />
			<h2>This information will be used each time you login to My Health by Design:</h2>
			<ul>
				<li>
					<label for="username">*Username:</label>
					<input id="txtUsername" type="text" />
				</li>
				<li>
					<label for="password">*Password:</label>
					<input id="txtPassword" type="password" />
				</li>
				<li>
					<span style="font-weight: bold; margin-left:-8px; padding-right: 7px;">*Confirm Password:</span>
					<input id="txtConfirmPassword" type="password" />
				</li>
				<li>
					<label for="mobile">Mobile Phone:</label>
					<input id="txtMobile" type="text" />
				</li>
				<li>
					<input type="checkbox" name="chkBxApp" value="app"/>I would like to download My Health by Design phone app.<br/>
				</li>
			</ul><br /><br />
			<span style="padding-left: 148px">
				<button class=" awesomebtn green" title="My Health Desire" onclick="location.href='health-desire.html'" >Continue &raquo;</button> 
			</span><br />
			<span style="color: gray; font-size: 12px;">*Required Field</span>
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